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Introduction Immune-related adverse events (irAEs) constitute a challenge in the clinical management of solid tumors. This study aims to collect real-world data on the occurrence of immune-mediated diarrhea and colitis (IMDC) in advanced non-small cell lung cancer (aNSCLC) treated with immune checkpoint inhibitors (ICIs) and to assess the clinical impact of a multidisciplinary approach (MDA) on IMDC management. Methods We retrospectively collected data on patients with aNSCLC consecutively treated with ICIs, either as single agent or in combination with chemotherapy, between September 2013 and July 2022. Among patients developing IMDC, we conducted blinded revision of colonic biopsies and evaluated the clinical impact of the introduction of MDA through predefined indicators. Results Among the 607 patients included, 84 (13.8%) experienced IMDC. Pathological review highlighted a high prevalence of microscopic colitis (28%), with a collagenous pattern linked to longer symptoms duration (P  = .01). IMDC occurred more frequently in females (P  = .05) and PD-L1 expressors (P  = .014) and was correlated with longer progression-free survival (17.0 vs 5.8, P  < .001) and overall survival (28.3 vs 9.5, P  < .001). The introduction of MDA was associated with increased employment of diagnostical tools such as fecal calprotectin test (P  < .001), colonoscopy (P  < .001), and gastroenterological evaluation (P  = .017) and a significant decrease in both grade 3 conversion rate (P  = .046) and recurrence after rechallenge (P  = .016). Hospitalization rate dropped from 17.2% to 3.8% (P : ns). Conclusion These findings highlight the clinical relevance of IMDC and support the incorporation of a MDA to optimize the clinical management of this irAE to improve patient care. Prospective validation has been planned. [ABSTRACT FROM AUTHOR]

The article in the journal "Colorectal Disease" discusses a case of simultaneous total laparoscopic double segmental resection with transanal natural orifice specimen extraction for deep endometriosis infiltrating the ileocaecal valve and rectum. The procedure was performed on a 31-year-old woman with drug treatment failure and various symptoms. The surgery was successful without complications, and the authors believe that this technique could be standardized for selected cases of multiple colorectal deep endometriotic nodules. [Extracted from the article]

[Display omitted] In the last years, monoclonal antibodies (mAbs) have rapidly escalated as biopharmaceuticals into cancer treatments, mainly for their target specificity accompanied by less side effects than the traditional chemotherapy, and stimulation of reliable long-term anti-tumoral responses. They are potentially unstable macromolecules under shaking, temperature fluctuations, humidity, and indoor and outdoor light exposure, all stressors occurring throughout their production, transport, storage, handling, and administration steps. The chemical and physical modifications of mAbs can lead not only to the loss of their bioactivity, but also to the enhancement of their immunogenicity with increasing risk of severe hypersensitivity reactions in treated patients because of aggregation. The photostability of Nivolumab, the active principle of Opdivo®, has been here studied. The chemical modifications detected by LC-MS/MS after the light stressor showed Trp and Met mono and double oxidations as primary damage induced by light on this mAb. The oxidations were stronger when the mAb was diluted in sterile glucose solution where 5-HMF, a major heat glucose degradation product, acted as singlet oxygen producer under irradiation. However, no significant changes in the mAb conformation were found. On the contrary, formation of a significant extent of aggregates has been detected after shining high simulated sunlight doses. This again took place particularly when Nivolumab was diluted in sterile glucose, thus raising a direct correlation between the aggregation and the oxidative processes. Finally, the biological activity under light stress assessed by a blockade assay test demonstrated the maintenance of the PD-1 target recognition even under high light doses and in glucose solution, in line with the preservation of the secondary and tertiary structures of the mAb. Based on our results, as sterile glucose is mostly used for children's therapies, special warnings, and precautions for healthcare professionals should be included for their use to the pediatric population. [ABSTRACT FROM AUTHOR]

[Display omitted] • This work is the first extensively investigating monoclonal stability not only by physicochemical, but also by multiple biological assays. • Cetuximab and panitumumab vial leftovers and dilution bags stability resulted extended respect to their SmCPs. • In hospitals, monoclonals' residues could be used reducing waste of both time and costs, optimising therapies' schedules. • Relevant data regarding mAbs differential response to thermal and chemical stress are reported, providing a wider understanding of formulation's influence on stability. The two anti-epidermal growth factor receptor monoclonal antibodies (mAbs) cetuximab and panitumumab are the pillars for the treatment of EGFR-positive, KRAS wild-type metastatic colorectal cancers. However, stability data of these mAbs are generally missing or incomplete. Here, we report for the first time an orthogonal analysis of the stability of cetuximab (Erbitux®) and panitumumab (Vectibix®), either undiluted vial leftovers or saline dilutions in polyolefin/polyamide infusion bags. All samples were stored at 2–8 °C protected from light, according to their summary of product characteristics (SmPCs). Alternatively, opened vials and preparations were maintained at 25 °C for 15 h, and then stored again at 2–8 °C protected from light to mimic a temporary interruption of the cold chain. Vial leftovers proved stable up to 180 days when stored according to their SmPCs, while compounded preparations in infusion bags maintained their physiochemical, biological and microbiological stability up to 30 days. Additionally, no changes were detected up to 30 days for the same samples undergoing a thermal excursion. Our results provide additional rationale to the SmPCs, crucial especially in the case of reassignment and pre-preparation of bags. This information will allow hospitals to achieve significant cost savings, and better organization of the entire therapeutic process. [ABSTRACT FROM AUTHOR]